Açik açılı glokomlu hastalarda gonioskopi asiste transluminal trabekulotomi sonuçlarinin değerlendirilmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Açık açılı glokom (AAG) hastalarında gonioskopi asiste transluminal trabekülotomi (GATT) cerrahi sonuçlarının etkinliği ve güvenirliliğinin değerlendirilmesi GEREÇ ve YÖNTEM: Kliniğimizde Ocak 2021-Şubat 2022 tarihleri arasında maksimal antiglokomatöz tedaviye rağmen hedef GİB'e ulaşılamayan 11 AAG'lu olgunun 11 gözüne GATT cerrahisi uygulandı (grup1 ). Cerrahi sonuçlar ve postoperatif komplikasyonlar, benzer demografik ve klinik özelliklere sahip ve aynı tarihler arasında trabekülektomi cerrahisi uygulanan 11 AAG hastasının 11 gözden oluşan kontrol grubu ile kıyaslandı ( grup 2). Her iki grup için preoperatif ve postoperatif dönemde en iyi düzeltilmiş görme keskinliği (EİDGK), GİB, antiglokomatöz ilaç sayısı, retina sinir lif tabakası (RNFL) kalınlığı ve komplikasyonlar kaydedildi. Her iki grup arasında belirtilen parametreler karşılaştırıldı. BULGULAR: Grup 1 ve 2 için sırasıyla ortalama yaşı 56,5±19,8 (18-80), 59,4±6,9 (16- 77) yıl idi (p>0,05). Her iki grupta cinsiyet benzerdi (7(%63,6) erkek, 4(%36,3) kadın) (p>0,05). Grup 1 için primer tanı gözlerin 3'ünde (%27,3) psödoeksfoliyatif glokom, 3'ünde (%27,3) primer açık açılı glokom, 2'sinde (%18,2) silikon yağı glokomu, 2'sinde (%18,2) fuchs üveiti glokomu, 1'inde (%9,1) konjenital glokom idi. Grup 2'de primer tanılar grup 1'e benzerlik göstermekteydi. GATT cerrahisi öncesi ortalama GİB 36,8±8,9 (19-51) mmHg iken son vizitte 15,3±3,3 (12-20) mmHg'ya istatiksel olarak anlamlı düşüş gösterdi (ANOVA, p=0,119). Grup 2'de preoperatif ortalama 30,5±0,69 (21-44) mmHg olan GİB, son vizitte 16,6±3,9 (12-22) mmHg ile istatiksel olarak anlamlı düşüş gösterdi (ANOVA, p=0,119). Tüm zaman noktalarında gruplar arasında anlamlı farklılık gözlenmedi (p=0,279). Grup 1'de topikal antiglokomatöz etken sayısı preoperatif dönemde 2,5±0,5 (3-4) iken, postoperatif son muayenede 0,5±0,5 (0-2) ile istatiksel olarak anlamlı derecede azaldı (Fisher'ın tam olasılık testi, p<0,001). Grup 2'de topikal antiglokomatöz etken sayısı preoperatif 4,0±0,0 iken, son muayenede 0,9±1,1 (0-4) ile istatiksel olarak anlamlı azalma saptandı (Fisher'ın tam olasılık testi, p<0,001). Gruplar arasında istatistiksel olarak anlamlı fark gözlenmedi (p=0,708). Her iki grup için preoperatif ve postoperatif dönemde en iyi düzeltilmiş görme keskinliği (EİDGK) karşılaştırıdı. Her iki grup arasında anlamlı fark izlenmedi (p>0,05 Mann Whitney U). Grup 1'de preoperatif ortalama RNFL kalınlığı 72,9±16,9 (50-90) µm iken, son muayenede 71,5±15,0 (48-88) µm ile takip süresince stabil kaldı (p=0,412). Grup 2'de preoperatif ortalama RNFL, son muayene ile anlamlı değişiklik göstermedi (p=0,412). Her iki grup arasında anlamlı fark izlenmedi (p=0,275). Grup 1'de postoperatif erken dönemde (?1ay) 2 olguda hifema , 3 olguda ise korneal ödem gelişti. Toplam iki olguda hedeflenen 7 GİB'a ulaşılamaması nedeni ile trabekülektomi gerekti. Grup 2'de erken dönemde 2 olguda hipotoni gelişti. Her iki grupta postoperatif geç dönem komplikasyon izlenmedi. SONUÇ: Çalışmamızda GATT cerrahisi ile AAG hastalarımızın % 81,2'sinde (11 hastanın 9'unda) takip süresince etkin GİB düşüşü sağlanmış, ortalama EİDGK ve RNFL değerleri korunmuş, topical anti-glokomatöz ilaç sayısında azalma saptanmıştır. Kontrol grubu ile kıyaslandığında cerrahi başarı ve komplikasyon oranlarını benzer saptadığımız bu prosedürün, trabekülektomiye alternatif etkin ve güvenilir bir seçenek olabileceği kanısına varılmıştır. Anahtar Kelimeler: Glokom; gonioskopi asiste transluminal trabekülotomi; göz içi basıncı
PURPOSE: To evaluate the efficacy and complications of gonioscopy assisted transluminal trabeculotomy (GATT) for treatment in open angle glaucoma. MATERIALS and METHODS: In this prospective study, GATT was performed in eyes with intraocular pressure above the target pressure despite medical treatment and with open angle glaucoma between January 2021 and February 2022 in Ege University Ophthalmology Department. The control group consisted of age and sex matched, open angle glaucoma patients with high IOP despite medical treatment. Trabeculectomy was the preffered surgery in control group. The best corrected visual acuity (BCVA), changes in intraoculer pressure (IOP), number of antiglaucoma drugs, retinal nerve fiber layer (RNFL) thickness and postoperative complications of the patients before and after surgery were examined. RESULTS: The mean age for groups 1 and 2 was 56.5±19.8 (18-80), 59.4±6.9 (16-77) years, respectively (p>0.05). Gender was similar in both groups (7(63.6%) male, 4(36.3%) female) (p>0.05) . For group 1, the primary diagnosis was pseudoexfoliative glaucoma in 3 (27.3%) eyes, primary open-angle glaucoma in 3 (27.3%), silicone oil glaucoma in 2 (18.2%) eyes, and 2 had fuchs uveitis glaucoma and 1 (9.1%) had congenital glaucoma. Primary diagnoses in group 2 were similar to group 1. While the mean IOP was 36.8±8.9 (19-51) mmHg before GATT surgery, it decreased statistically to 15.3±3.3 (12-20) mmHg at the last visit (ANOVA, p=0.119). The mean IOP, which was 30.5±0.69 (21-44) mmHg preoperatively in Group 2, decreased statistically to 16.6±3.9 (12-22) mmHg at the last visit (ANOVA, p=0.119). No significant difference was observed between the groups at all time points (p=0.279). While the number of topical antiglaucomatous agents was 2.5±0.5 (3-4) in the preoperative period in Group 1, it was statistically significantly decreased by 0.5±0.5 (0-2) at the last postoperative examination (Fisher's full probability test, p<0.001). While the number of topical antiglaucomatous agents was 4.0±0.0 preoperatively in Group 2, a statistically significant decrease was found at the last examination with 0.9±1.1 (0-4) (Fisher's full probability test, p<0.001). No statistically significant difference was observed between the groups (p=0.708). The best corrected visual acuity (BCVA) was compared in the preoperative and postoperative period for both groups. There was no significant difference between the two groups (p>0.05 Mann Whitney U). While the preoperative mean RNFL thickness was 72.9±16.9 (50-90) µm in Group 1, it remained stable during the follow-up with 71.5±15.0 (48-88) µm at the last examination (p=0.412). In group 2, preoperative mean RNFL did not change significantly with the last examination (p=0.412). There was no significant difference between the two groups (p=0.275). In Group 1, hyphema developed in 2 cases and corneal edema in 3 cases in the early postoperative period (?1 month). In two cases, trabeculectomy was required because the targeted IOP could not be reached. In Group 2, hypotonia developed in 2 cases in the early period. No late postoperative complications were observed in either group. CONCLUSION: In our study, effective IOP reduction was achieved in 81.2% of our OAG patients (9 out of 11 patients) with GATT surgery during the follow-up period, mean BCVA and RNFL values were preserved, and a decrease in the number of topical anti-glaucomatous drugs was detected. It was concluded that this procedure, in which we found similar surgical success and complication rates compared to the control group, may be an effective and safe alternative to trabeculectomy. Key words: Glaucoma; gonioscopy assisted transluminal trabeculotomy; surgical outcome
PURPOSE: To evaluate the efficacy and complications of gonioscopy assisted transluminal trabeculotomy (GATT) for treatment in open angle glaucoma. MATERIALS and METHODS: In this prospective study, GATT was performed in eyes with intraocular pressure above the target pressure despite medical treatment and with open angle glaucoma between January 2021 and February 2022 in Ege University Ophthalmology Department. The control group consisted of age and sex matched, open angle glaucoma patients with high IOP despite medical treatment. Trabeculectomy was the preffered surgery in control group. The best corrected visual acuity (BCVA), changes in intraoculer pressure (IOP), number of antiglaucoma drugs, retinal nerve fiber layer (RNFL) thickness and postoperative complications of the patients before and after surgery were examined. RESULTS: The mean age for groups 1 and 2 was 56.5±19.8 (18-80), 59.4±6.9 (16-77) years, respectively (p>0.05). Gender was similar in both groups (7(63.6%) male, 4(36.3%) female) (p>0.05) . For group 1, the primary diagnosis was pseudoexfoliative glaucoma in 3 (27.3%) eyes, primary open-angle glaucoma in 3 (27.3%), silicone oil glaucoma in 2 (18.2%) eyes, and 2 had fuchs uveitis glaucoma and 1 (9.1%) had congenital glaucoma. Primary diagnoses in group 2 were similar to group 1. While the mean IOP was 36.8±8.9 (19-51) mmHg before GATT surgery, it decreased statistically to 15.3±3.3 (12-20) mmHg at the last visit (ANOVA, p=0.119). The mean IOP, which was 30.5±0.69 (21-44) mmHg preoperatively in Group 2, decreased statistically to 16.6±3.9 (12-22) mmHg at the last visit (ANOVA, p=0.119). No significant difference was observed between the groups at all time points (p=0.279). While the number of topical antiglaucomatous agents was 2.5±0.5 (3-4) in the preoperative period in Group 1, it was statistically significantly decreased by 0.5±0.5 (0-2) at the last postoperative examination (Fisher's full probability test, p<0.001). While the number of topical antiglaucomatous agents was 4.0±0.0 preoperatively in Group 2, a statistically significant decrease was found at the last examination with 0.9±1.1 (0-4) (Fisher's full probability test, p<0.001). No statistically significant difference was observed between the groups (p=0.708). The best corrected visual acuity (BCVA) was compared in the preoperative and postoperative period for both groups. There was no significant difference between the two groups (p>0.05 Mann Whitney U). While the preoperative mean RNFL thickness was 72.9±16.9 (50-90) µm in Group 1, it remained stable during the follow-up with 71.5±15.0 (48-88) µm at the last examination (p=0.412). In group 2, preoperative mean RNFL did not change significantly with the last examination (p=0.412). There was no significant difference between the two groups (p=0.275). In Group 1, hyphema developed in 2 cases and corneal edema in 3 cases in the early postoperative period (?1 month). In two cases, trabeculectomy was required because the targeted IOP could not be reached. In Group 2, hypotonia developed in 2 cases in the early period. No late postoperative complications were observed in either group. CONCLUSION: In our study, effective IOP reduction was achieved in 81.2% of our OAG patients (9 out of 11 patients) with GATT surgery during the follow-up period, mean BCVA and RNFL values were preserved, and a decrease in the number of topical anti-glaucomatous drugs was detected. It was concluded that this procedure, in which we found similar surgical success and complication rates compared to the control group, may be an effective and safe alternative to trabeculectomy. Key words: Glaucoma; gonioscopy assisted transluminal trabeculotomy; surgical outcome
Açıklama
Anahtar Kelimeler
Göz Hastalıkları, Eye Diseases
